Insurance woes affecting well being

I am totally confused on what to do and need to write it out in an attempt to make some sense of it all.

I have had insurance issues since the day I became an adult with my own insurance. Prescription coverage has been such a problem that I am now an expert at fixing this. Well maybe not an expert as in December I discovered I was over charged in November for a new script. I vowed I would not allow this to happen again. It did happen again and now I have a new pharmacy. Mistakes are bound to happen, but 4 in 6 months? And the same mistake over and over again is not acceptable.
Prescription coverage is not what I need to discuss.

I am covered by 3 insurances. They have worked well together for the last 5 years. I have had minimal out of pocket costs. The copays from one insurance are covered by another. I have been grateful as I know that if this was not the case, I would have been unable to afford the therapy and treatments I have received. I am so much better because of this.
The other day I went to my regular therapy appointment. I was informed that I had a $20 copay and it goes back to the first of the year. I did not have $20 so I chose to leave. Although later they said I did not have to pay that day. I owe them a lot of money that I do not have. But that, I could easily work out.

The problem is me. I am unwilling to pay for a mistake that I did not make. It is a mistake. I can't figure out who's mistake it is or how to resolve it. I have been dealing with newer insurance miscommunications since August. I keep getting told "it is all fixed and we apologize for the inconvenience" or "you need to talk to them as we can't fix it" or " we don't do that. The doctor will have to submit it to all insurances again." and on and on it goes.
The only change in insurance was effective December 1, 2015. This change did not affect coverage.
Had I been aware that I was going to be responsible for copays all of a sudden, I would have done things different. I would have seen T less and dealt with that. If I am now responsible for copays with my Therapist and Psychiatrist, why am I not with my regular Doctors? Why, all of a sudden are my copays not covered? If I had received an explanation prior to learning this copay crap, I would feel different. If something changed, I should have been informed. If I had been informed with an explanation, I would fee different about this all. Yes, it is the principle of the thing.

I have 2 options dueling in my head right now.

• Do I suck it up, give in, and pay a bill I am not responsible for in order to continue therapy and meds?
• Do I look at it another way and accept that maybe this is meant to be. Maybe I have learned what I need to learn and no longer need the help of a therapist?

I do know one thing for sure. I need my medication. I have not had a major depressive episode in a long time (although I do sense one starting). The medication I take has been doing a fine job helping me deal with OCD. Although recently it has been a bit harder. My primary Care Doc might be willing to help out with the medication, but she would rather I be under the care of a psychiatrist.

If anyone has experience, insight, thoughts, etc. I would appreciate hearing from you. I have more to add, but need to stop so I can go kill zombies. Killing zombies is a great distraction and I feel better when done.

Hi Emwell. I had similiar issues.. the therapists are billed separately from the pcp. One is not copay while after it seems so many visits you pay or copay for the visits. i think i was allowed so many free ones, then they changed the rules after so many visits. that is something you might want to check out. ask for a written statement of their billing practices concerning you and your medical needs. If you need the meds your pcp can keep you on them, go to a therapist perhaps every quarter rather than all the time. don't burn your bridges. you probably are like me you are a person of principles and you will stand by them even if you cut off your nose to spite your face. well get it in writing what you are to pay or not pay and bring it with you every time so they can make photocopies of it... i think someone somewhere put in a wrong billing code on you personally. check them out on your bill... you can google the code and that helps. I wish you the best my friend. You are responsible for your own bills. You have to decide what is more important, making payments to stay on your medicines or just go with what you have and have your pcp continue to update the scripts for them every three months without continuing therapy. (((hugs))) blessings

Sorry you're having these issues, Emwell ...

I thought the new healthcare law was going to help us with all
this ... Alas, it seems to have created even more confusion than
there was before it even went into effect!

I dread the day I retire and have to go on Medicare!

Too pfunny my pfriend. You are right to dread it. My husband turned 65 and was pforced to take and pay for Medicare that he did not want. He was quite happy with the insurance we had. His prior insurance turned into a subsidiary/secondary (i am not sure what they call it). That meant the regular insurance had to go back in my name. Our insurance premiums have sky rocketed due to these changes. We now pay for 3 separate insurances instead of 1 family plan. I do not think this change affected my copay as this change occurred a month before the co pay issue started. Still, I was not notified of any policy changes.

Oh and our premiums and coverage changed for the worse when the new healthcare crap went through. It may have been coincidental, but our premiums went up and our coverage went down.

One final ***** while I am at it. Husband can't get the social security he is owed unless they change some laws that are less than fair.

I use to do Medical billing ... The way insurance companies work is they often deny coverage for no "legal" reason .. they know that a certain amount of people wont question it and just go ahead and write a check. They kinda bank on that.

Health coverage has gotten so confusing across the board .. Literally now a days when I call the billing office my T uses and they tell me X but it doesnt match up with what my EOB from medicare shows its like pulling teeth to get them to realize that they infact are not applying the insurance payment correctly or at all .

When your dealing with mulitiple insurance , well yes its becomes beyond confusing.. again Insurance companies are banking on that ... any reason for them not to pay .. right?

I guess since I had done medical billing for years and years I am more likely to argue and show people how uninformed they are.

Only you can decide if the fight is worth the mental and physical toll it will take.

I hope you find a solution to all this brand new sparkly insurance that was suppost to make things better and easier

One thing I do if I am given any new medication ,,I call the insurance company directly and ask them the price before I even go to fill it. Once I do fill it... if its not the exact amount I ask the pharmacy to call right then and there while I am calling them too. Squeeky wheel kinda deal.

Hope you can get things sorted out

Thanks Christina. Sadly, what you say makes total sense. I am one of those who must question everything when it comes to health coverage. I am very aware of my benefits. So if something is wrong or different, I know it right away. Learning in May that I owe copays for the whole year is different and wrong. Very wrong.

The prescription coverage issue started in November. Odd, that is around the time the veteran pharmacist left. (coincidence I think) I also caught them in an outright lie last summer regarding the price of a simple thyroid med if not using insurance. (it was $10 when I asked, but when my Vet sent in the script a day later it went to $60.) same drug, same strength, different species????

I now have a new smaller pharmacy where I am being charged correctly. They were recommended by my MedDude. I figure if anyone knows which is best, it would be him. he specifically said, "they are good advocates for my patients"

Right now I choose to wait. I may end up fighting, but I need to wait until I am better able to handle a fight. My therapist and MedDude are awesome. If I am suppose to have them in my life, I will. Odd, last week I was unhappy with MedDude. I will be okay for awhile as far as meds go So seeing him is not a priority.

FYI ---- this last paragraph is not me. I am normally very impulsive and great at burning bridges. I react then deal with the outcome.

My insurance woes are over. At least until the next time.
I did not call them, I talked to no one. I waited. I waited and just felt feelings. I did what I could to not react.
I knew in my heart I was right. I chose to try and accept that whatever happens is meant to happen.
That is when I got a message from the office of my T and MedDude explaining that everything has been taken care of. I owe nothing now or in the near future.

Wonderful